{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA J DIAMOND","gend":1,"add":"117 TANNIES TRAIL SE ","city":"FLOYD ","state":"VA","zip":"24091-9998","dob":"1958-09-05","age":"","mstatus":"","insh":11012076,"cliId":"3FR1NK0DN31","pno":5402390300,"cno":5402390300,"email":"","ename":"","eno":"","pphy":"TRIVEDI, RAJENDRA S  ","ppno":4347923730,"pcpadd":"501 Rison St,Ste 120","pcpcity":"Danville ","pcpstate":"VA","pcpzip":245412426,"pcpcounty":"","pcpid":"P0060294","pcpname":"MEMORIAL FAMILY CARE INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"117 TANNIES TRAIL SE ","madd2":"","madd3":"","mcity":"FLOYD ","mstate":"VA","mzip":"24091-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M06.9","G89.4","F41.9","M51.06","J44.1","H83.09","J30.9","R05","Z00.00","G47.00","F33.1","K21.0","F41.1","Z13.31","M54.5","W19.XXXA","R07.81","R91.8","S52.502A","S52.602A","S52.572A","M25.532","W10.9XXA","Y93.9","Y92.9","J44.9","I10","S52.592D","S52.692D","S52.552A","S52.692A","S52.502D","K21.9","F17.210","S52.552D","S52.602D","R19.7","M51.36","M81.0","E05.90","E78.5","M06.89","Z79.891","Z79.899","R42","Z68.1","E55.9","E03.9","R73.09","M79.2","B37.0","J44.0","Z00.01","R11.2","Z13.89","R05.9","J18.9","S22.42XA","J90","R06.2","R07.89","R06.02","Z20.822","J96.11","Z99.81","D72.829","F32.A","R79.89","G89.29","G62.9","J98.4","R94.31","J96.01","R50.9"],"date":["2021-11-08","2021-10-11","2021-10-20","2021-10-11","2021-10-20","2020-03-17","2020-07-27","2021-08-02","2020-06-16","2020-12-14","2020-06-16","2020-06-16","2021-09-09","2020-06-16","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2021-11-07","2021-06-14","2020-06-25","2020-06-25","2020-07-01","2020-07-01","2020-07-24","2020-07-27","2021-10-19","2020-08-27","2020-08-27","2020-09-24","2020-07-27","2020-07-27","2021-10-20","2021-06-14","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2021-03-15","2021-03-15","2021-03-15","2021-09-09","2021-03-15","2021-08-02","2021-06-14","2021-06-14","2021-06-14","2021-10-19","2021-10-20","2021-10-20","2021-10-19","2021-10-19","2021-11-15","2021-10-19","2021-10-19","2021-10-19","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-19","2021-10-19","2021-10-20","2021-11-15"],"priorHcc":[null,null,"",null,"","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","",null]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","310009530","DALIRESP","TAB 500MCG","","Select","Select",""],["","597007541","SPIRIVA","CAP HANDIHLR","","Select","Select",""],["","173088710","TRELEGY","AER ELLIPTA","","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","378668910","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","23155007001","METHIMAZOLE","TAB 5MG","","Select","Select",""],["","487980160","IPRATROPIUM","SOL 0.02%INH","","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","","Select","Select",""],["","172392770","DIAZEPAM","TAB 10MG","","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","","Select","Select",""],["","54472825","PREDNISONE","TAB 5MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","59651017301","DOXEPIN HCL","CAP 10MG","","Select","Select",""],["","27808003703","HYDROCO\/APAP","TAB 10-325MG","","Select","Select",""],["","59762644303","SERTRALINE","TAB 50MG","","Select","Select",""],["","10702005650","OXYCODONE","TAB 10MG","","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","49884090738","MEGESTROL AC","SUS 40MG\/ML","","Select","Select",""],["","59762106101","DIPHEN\/ATROP","TAB 2.5MG","","Select","Select",""],["","10702000310","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","69547035302","NARCAN","SPR ","","Select","Select",""],["","65862019399","FLUOXETINE","CAP 20MG","","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","","Select","Select",""],["","310009530","DALIRESP ","TAB 500MCG","30","Select","Select",""],["","23155007001","METHIMAZOLE ","TAB 5MG","90","Select","Select",""],["","173088710","TRELEGY ","AER ELLIPTA","60","Select","Select",""],["","597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","60505258008","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","378668910","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","487980160","IPRATROPIUM ","SOL 0.02%INH","150","Select","Select",""],["","65162006205","SUCRALFATE ","SUS 1GM\/10ML","420","Select","Select",""],["","172392770","DIAZEPAM ","TAB 10MG","120","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","270","Select","Select",""],["","173068220","VENTOLIN ","AER ","18","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","20","Select","Select",""],["","54472825","PREDNISONE ","TAB 5MG","21","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","59651017301","DOXEPIN ","CAP 10MG","30","Select","Select",""],["","59762644303","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","10702005650","OXYCODONE ","TAB 10MG","60","Select","Select",""],["","53746011005","HYDROCO\/APAP ","TAB 10-325MG","120","Select","Select",""],["","68382009405","CARVEDILOL ","TAB 12.5MG","180","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","49884090738","MEGESTROL ","SUS 40MG\/ML","300","Select","Select",""],["","65862019399","FLUOXETINE ","CAP 20MG","90","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","200","Select","Select",""],["","10702000310","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","59762106101","DIPHEN\/ATROP ","TAB 2.5MG","10","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","10","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","49884090738","MEGESTROL","40MG\/ML","240","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","59651017301","DOXEPIN","10MG","30","Select","Select",""],["","65862018730","ONDANSETRON","4MG","10","Select","Select",""],["","57237023305","SMZ-TMP","800-160","20","Select","Select",""],["","55111028050","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","20","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","6","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}